Michael Cookson, MD, MMHC, talks with Alicia Morgans, MD on the newest developments in the AUA CRCP guidelines and how they have adapted with the latest results of the SPARTAN and PROSPER nmCRPC studies. The purpose of this guideline amendment is essentially to update current management of index patient 1: asymptomatic non-metastatic CRPC. Michael shares there is a need to revamp current guidelines which are shifting into advanced prostate cancer, the hormone-sensitive space, newly diagnosed disease, and not just focusing on castration-resistant disease but focusing on the whole management of the advanced metastatic disease.

Interesting interview. The focus is on non-metastatic castrate resistant prostate cancer. But about 2/3 of the way through the interview Dr. Cookson mentions also that investigations are starting to evaluate apalutamide and enzalutamide (Xtandi) in non-metastatic castrate sensisitive PCa.

I am in the control arm of a trial that has just begun to compare 1) standard treatment -- Degeralix - a.k.a. Firmagon vs. 2) Degeralix plus Apalutamide, vs. 3) Degeralix plus Apalutamide plus abiraterone acetate (Zytiga) in patients like me who have biochemical recurrence and are still castrate sensitive. After the first year patients will have follow-up clinical exams and questionnaires for another 4 years. Beyond that there may be indefinite follow-up by telephone or questionnaire etc.

I'm not disappointed to have been randomized into the standard treatment arm, though I'd have preferred the Degeralix plus Apalutamide arm. For anyone who is potentially eligible and interested, here is a link:

Unfortunately, once you develop detectable mets, most of the clinical trials lose interest in you.....

One reason for that may be that the drug companies that sponsor most of these trials want the best results possible to give them the best shot at FDA approval which opens the door to the big bucks...Age now 75 . Diagnosed G-9 6/2010. RALP, Radiation failed Lupron, Zytiga, PSA <0.1 10/16 no change <0.1 5/17 PSA 1.6 Chemo or Provenge next..Sept '17, PSA now 9.2. ADT including Zytiga has failed. Will investigate treatment options. 11/17 PET/CT clear, but 4 new bone mets..Going to try Xtandi and see how I respond to that..3/2018 PSA now 54, chemo next. 5?10/18, PSA 200, Dosetaxel started..